Comparative safety and efficacy of vasopressors for mortality in septic shock: A network meta-analysis

© 2015, © The Intensive Care Society 2015.Introduction: Septic shock is a life-threatening condition requiring vasopressor agents to support the circulatory system. Several agents exist with choice typically guided by the specific clinical scenario. We used a network meta-analysis approach to rate the comparative efficacy and safety of vasopressors for mortality and arrhythmia incidence in septic shock patients. Methods: We performed a comprehensive electronic database search including Medline, Embase, Science Citation Index Expanded and the Cochrane database. Randomised trials investigating vasopressor agents in septic shock patients and specifically assessing 28-day mortality or arrhythmia incidence were included. A Bayesian network meta-analysis was performed using Markov chain Monte Carlo methods. Results: Thirteen trials of low to moderate risk of bias in which 3146 patients were randomised were included. There was no pairwise evidence to suggest one agent was superior over another for mortality. In the network meta-analysis, vasopressin was significantly superior to dopamine (OR 0.68 (95% CI 0.5 to 0.94)) for mortality. For arrhythmia incidence, standard pairwise meta-analyses confirmed that dopamine led to a higher incidence of arrhythmias than norepinephrine (OR 2.69 (95% CI 2.08 to 3.47)). In the network meta-analysis, there was no evidence of superiority of one agent over another. Conclusions: In this network meta-analysis, vasopressin was superior to dopamine for 28-day mortality in septic shock. Existing pairwise information supports the use of norepinephrine over dopamine. Our findings suggest that dopamine should be avoided in patients with septic shock and that other vasopressor agents should continue to be based on existing guidelines and clinical judgement of the specific presentation of the patient

Formal Availability Analysis using Theorem Proving

Availability analysis is used to assess the possible failures and their restoration process for a given system. This analysis involves the calculation of instantaneous and steady-state availabilities of the individual system components and the usage of this information along with the commonly used availability modeling techniques, such as Availability Block Diagrams (ABD) and Fault Trees (FTs) to determine the system-level availability. Traditionally, availability analyses are conducted using paper-and-pencil methods and simulation tools but they cannot ascertain absolute correctness due to their inaccuracy limitations. As a complementary approach, we propose to use the higher-order-logic theorem prover HOL4 to conduct the availability analysis of safety-critical systems. For this purpose, we present a higher-order-logic formalization of instantaneous and steady-state availability, ABD configurations and generic unavailability FT gates. For illustration purposes, these formalizations are utilized to conduct formal availability analysis of a satellite solar array, which is used as the main source of power for the Dong Fang Hong-3 (DFH-3) satellite.Comment: 16 pages. arXiv admin note: text overlap with arXiv:1505.0264

Contribution of regional aerosol nucleation to low-level CCN in an Amazonian deep convective environment: results from a regionally nested global model

Global model studies and observations have shown that downward transport of aerosol nucleated in the free troposphere is a major source of cloud condensation nuclei (CCN) to the global boundary layer. In Amazonia, observations show that this downward transport can occur during strong convective activity. However, it is not clear from these studies over what spatial scale this cycle of aerosol formation and downward supply of CCN is occurring. Here, we aim to quantify the extent to which the supply of aerosol to the Amazonian boundary layer is generated from nucleation within a 1000 km regional domain or from aerosol produced further afield and the effectiveness of the transport by deep convection. We run the atmosphere-only configuration of the HadGEM3 climate model incorporating a 440 km × 1080 km regional domain over Amazonia with 4 km resolution. Simulations were performed over several diurnal cycles of convection. Below 2 km altitude in the regional domain, our results show that new particle formation within the regional domain accounts for only between 0.2 % and 3.4 % of all Aitken and accumulation mode aerosol particles, whereas nucleation that occurred outside the domain (in the global model) accounts for between 58 % and 81 %. The remaining aerosol is primary in origin. Above 10 km, the regional-domain nucleation accounts for up to 66 % of Aitken and accumulation mode aerosol, but over several days very few of these particles nucleated above 10 km in the regional domain are transported into the boundary layer within the 1000 km region, and in fact very little air is mixed that far down. Rather, particles transported downwards into the boundary layer originated from outside the regional domain and entered the domain at lower altitudes. Our model results show that CCN entering the Amazonian boundary layer are transported downwards gradually over multiple convective cycles on scales much larger than 1000 km. Therefore, on a 1000 km scale in the model (approximately one-third the size of Amazonia), trace gas emission, new particle formation, transport and CCN production do not form a “closed loop” regulated by the biosphere. Rather, on this scale, long-range transport of aerosol is a much more important factor controlling CCN in the boundary layer

Magnetic Catalysis and Quantum Hall Ferromagnetism in Weakly Coupled Graphene

We study the realization in a model of graphene of the phenomenon whereby the tendency of gauge-field mediated interactions to break chiral symmetry spontaneously is greatly enhanced in an external magnetic field. We prove that, in the weak coupling limit, and where the electron-electron interaction satisfies certain mild conditions, the ground state of charge neutral graphene in an external magnetic field is a quantum Hall ferromagnet which spontaneously breaks the emergent U(4) symmetry to U(2)XU(2). We argue that, due to a residual CP symmetry, the quantum Hall ferromagnet order parameter is given exactly by the leading order in perturbation theory. On the other hand, the chiral condensate which is the order parameter for chiral symmetry breaking generically obtains contributions at all orders. We compute the leading correction to the chiral condensate. We argue that the ensuing fermion spectrum resembles that of massive fermions with a vanishing U(4)-valued chemical potential. We discuss the realization of parity and charge conjugation symmetries and argue that, in the context of our model, the charge neutral quantum Hall state in graphene is a bulk insulator, with vanishing longitudinal conductivity due to a charge gap and Hall conductivity vanishing due to a residual discrete particle-hole symmetry.Comment: 35 page

Galactic and Extragalactic Samples of Supernova Remnants: How They Are Identified and What They Tell Us

Supernova remnants (SNRs) arise from the interaction between the ejecta of a supernova (SN) explosion and the surrounding circumstellar and interstellar medium. Some SNRs, mostly nearby SNRs, can be studied in great detail. However, to understand SNRs as a whole, large samples of SNRs must be assembled and studied. Here, we describe the radio, optical, and X-ray techniques which have been used to identify and characterize almost 300 Galactic SNRs and more than 1200 extragalactic SNRs. We then discuss which types of SNRs are being found and which are not. We examine the degree to which the luminosity functions, surface-brightness distributions and multi-wavelength comparisons of the samples can be interpreted to determine the class properties of SNRs and describe efforts to establish the type of SN explosion associated with a SNR. We conclude that in order to better understand the class properties of SNRs, it is more important to study (and obtain additional data on) the SNRs in galaxies with extant samples at multiple wavelength bands than it is to obtain samples of SNRs in other galaxiesComment: Final 2016 draft of a chapter in "Handbook of Supernovae" edited by Athem W. Alsabti and Paul Murdin. Final version available at https://doi.org/10.1007/978-3-319-20794-0_90-

Individual, unit and vocal clan level identity cues in sperm whale codas

Fieldwork was supported by Discovery and Equipment grants to H.W. from the Natural Sciences and Engineering Research Council of Canada (NSERC) and the Whale and Dolphin Conservation Society. S.G. and L.R. were supported by the Marine Alliance for Science and Technology for Scotland (MASTs) pooling initiative and their support is gratefully acknowledged. MASTs is funded by the Scottish Funding Council (grant reference HR09011) and contributing institutions. S.G. was also supported by an NSERC Postgraduate Scholarship (PGS-M), an NSERC Canadian Graduate Scholarship (CGS-D), the Izaak Killam Memorial Scholarship, the Patrick F. Lett Fund, the Dalhousie’s Presidents Award, and an FNU fellowship for the Danish Council for Independent Research from the Ministry of Higher Education and Science supplemented by a Sapere Aude Research Talent Award.The ‘social complexity hypothesis’ suggests that complex social structure is a driver of diversity in animal communication systems. Sperm whales have a hierarchically structured society in which the largest affiliative structures, the vocal clans, are marked on ocean-basin scales by culturally transmitted dialects of acoustic signals known as ‘codas’. We examined variation in coda repertoires among both individual whales and social units—the basic element of sperm whale society—using data from nine Caribbean social units across six years. Codas were assigned to individuals using photo-identification and acoustic size measurement, and we calculated similarity between repertoires using both continuous and categorical methods. We identified 21 coda types. Two of those (‘1+1+3’ and ‘5R1’) made up 65% of the codas recorded, were shared across all units and have dominated repertoires in this population for at least 30 years. Individuals appear to differ in the way they produce ‘5R1’ but not ‘1+1+3’ coda. Units use distinct 4-click coda types which contribute to making unit repertoires distinctive. Our results support the social complexity hypothesis in a marine species as different patterns of variation between coda types suggest divergent functions, perhaps representing selection for identity signals at several levels of social structure.Publisher PDFPeer reviewe

Neo sex chromosomes, colour polymorphism and male-killing in the African queen butterfly, Danaus chrysippus (L.)

This is the final version. Available from MDPI via the DOI in this record. The following are available online at http://www.mdpi.com/2075-4450/10/9/291/s1, Figure S1: (a) Histograms showing the frequencies (per cent) of (A) females and (B–D) the three homozygous recessive phenotypes aa (B), bb (C) and cc (D) at Nairobi. Symbols on the co-ordinate: J = January, F = February, A = Insects 2019, 10, 291 20 of 25 April, M = May, J/A = July/August, N = November. x = the mean value of the six samples [13]; (b) Frequencies (per cent) as three-month moving averages for the cc genotype (o) and females (•) in monthly samples of D.chrysippus from February 1972 to September 1975 on the campus of the University of Dar es Salaam, Tanzania. The approximate durations of wet seasons (dashed lines indicating periods that are variable) and the two monsoons (SE = south–east, NE = north–east) are shown at the top [13]; Table S1: Sex ratios of Danaus chrysippus collected as eggs, Athi River Plains, Nairobi, 1986–1994. (Expected numbers if the true sex ratio is stable at 74.5% female in parentheses); Table S2: Disassortative (negative non-random) mating for C locus genotype (expected numbers in parentheses if mate choice is random) in D. chrysippus at Kitengela, Kenya, May–July 2015.Danaus chrysippus (L.), one of the world’s commonest butterflies, has an extensive range throughout the Old-World tropics. In Africa it is divided into four geographical subspecies which overlap and hybridise freely in the East African Rift: Here alone a male-killing (MK) endosymbiont, Spiroplasma ixodetis, has invaded, causing female-biased populations to predominate. In ssp. chrysippus, inside the Rift only, an autosome carrying a colour locus has fused with the W chromosome to create a neo-W chromosome. A total of 40-100% of Rift females are neo-W and carry Spiroplasma, thus transmitting a linked, matrilineal neo-W, MK complex. As neo-W females have no sons, half the mother’s genes are lost in each generation. Paradoxically, although neo-W females have no close male relatives and are thereby forced to outbreed, MK restricts gene flow between subspecies and may thus promote speciation. The neo-W chromosome originated in the Nairobi region around 2.2 k years ago and subsequently spread throughout the Rift contact zone in some 26 k generations, possibly assisted by not having any competing brothers. Our work on the neo-W chromosome, the spread of Spiroplasma and possible speciation is ongoing

Gate-Controlled Ionization and Screening of Cobalt Adatoms on a Graphene Surface

We describe scanning tunneling spectroscopy (STS) measurements performed on individual cobalt (Co) atoms deposited onto backgated graphene devices. We find that Co adatoms on graphene can be ionized by either the application of a global backgate voltage or by the application of a local electric field from a scanning tunneling microscope (STM) tip. Large screening clouds are observed to form around Co adatoms ionized in this way, and we observe that some intrinsic graphene defects display a similar behavior. Our results provide new insight into charged impurity scattering in graphene, as well as the possibility of using graphene devices as chemical sensors.Comment: 19 pages, 4 figure

Stepwise evolution of a butterfly supergene via duplication and inversion.

This is the final version. Available from the Royal Society via the DOI in this record. Data accessibility Sequencing reads and assemblies are available at the European Nucleotide Archive project (see the electronic supplementary material, table S1 for accession numbers [48]). Assemblies are available in the European Nucleotide Archive project accession PRJEB52180. Additional data files are available from the Dryad Digital Repository: https://doi.org/10.5061/dryad.xwdbrv1g0 [49], including genome assemblies and annotations, repeat library and windowed repeat content, whole-genome alignments, VCF and genotype files, window-based diversity and divergence measures and read depth, sequence alignments for genes and phylogenetic trees. Scripts for assembly polishing, the analysis of repeat content, genome annotation and phylogenetic tree construction are available at https://github.com/RishiDeKayne/Danaus_supergene_structure. Scripts for genome alignment and synteny block inference, ancestry painting and divergence analyses, and read depth and copy number analyses are available at https://github.com/simonhmartin/Danaus_supergene_structure.Supergenes maintain adaptive clusters of alleles in the face of genetic mixing. Although usually attributed to inversions, supergenes can be complex, and reconstructing the precise processes that led to recombination suppression and their timing is challenging. We investigated the origin of the BC supergene, which controls variation in warning coloration in the African monarch butterfly, Danaus chrysippus. By generating chromosome-scale assemblies for all three alleles, we identified multiple structural differences. Most strikingly, we find that a region of more than 1 million bp underwent several segmental duplications at least 7.5 Ma. The resulting duplicated fragments appear to have triggered four inversions in surrounding parts of the chromosome, resulting in stepwise growth of the region of suppressed recombination. Phylogenies for the inversions are incongruent with the species tree and suggest that structural polymorphisms have persisted for at least 4.1 Myr. In addition to the role of duplications in triggering inversions, our results suggest a previously undescribed mechanism of recombination suppression through independent losses of divergent duplicated tracts. Overall, our findings add support for a stepwise model of supergene evolution involving a variety of structural changes. This article is part of the theme issue 'Genomic architecture of supergenes: causes and evolutionary consequences'.Royal SocietyRoyal SocietySwiss National Science Foundation (SNSF)National Geographic Societ

Combinations of β-lactam or aminoglycoside antibiotics with plectasin are synergistic against methicillin-sensitive and methicillin-resistant Staphylococcus aureus.

Bacterial infections remain the leading killer worldwide which is worsened by the continuous emergence of antibiotic resistance. In particular, methicillin-sensitive (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) are prevalent and the latter can be difficult to treat. The traditional strategy of novel therapeutic drug development inevitably leads to emergence of resistant strains, rendering the new drugs ineffective. Therefore, rejuvenating the therapeutic potentials of existing antibiotics offers an attractive novel strategy. Plectasin, a defensin antimicrobial peptide, potentiates the activities of other antibiotics such as β-lactams, aminoglycosides and glycopeptides against MSSA and MRSA. We performed in vitro and in vivo investigations to test against genetically diverse clinical isolates of MSSA (n = 101) and MRSA (n = 115). Minimum inhibitory concentrations (MIC) were determined by the broth microdilution method. The effects of combining plectasin with β-lactams, aminoglycosides and glycopeptides were examined using the chequerboard method and time kill curves. A murine neutropenic thigh model and a murine peritoneal infection model were used to test the effect of combination in vivo. Determined by factional inhibitory concentration index (FICI), plectasin in combination with aminoglycosides (gentamicin, neomycin or amikacin) displayed synergistic effects in 76-78% of MSSA and MRSA. A similar synergistic response was observed when plectasin was combined with β-lactams (penicillin, amoxicillin or flucloxacillin) in 87-89% of MSSA and MRSA. Interestingly, no such interaction was observed when plectasin was paired with vancomycin. Time kill analysis also demonstrated significant synergistic activities when plectasin was combined with amoxicillin, gentamicin or neomycin. In the murine models, plectasin at doses as low as 8 mg/kg augmented the activities of amoxicillin and gentamicin in successful treatment of MSSA and MRSA infections. We demonstrated that plectasin strongly rejuvenates the therapeutic potencies of existing antibiotics in vitro and in vivo. This is a novel strategy that can have major clinical implications in our fight against bacterial infections